CDC Says Strange Skin Condition Not Infectious

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Morgellons is a lay term for an unexplained chronic, recurrent dermopathy. It is characterized by poorly healing skin lesions associated with pruritus and other disturbing cutaneous sensations.

This study found no evidence of an underlying medical condition or infectious source for this rare condition.

A mysterious condition in which cloth fibers or other materials are reported to emerge from the skin doesn't appear to be infectious, a CDC team said after studying a possible cluster of cases in northern California.

A wide range of tests turned up no single bacteria, mycobacteria, virus, or parasitic explanation for what is being called Morgellons, according to Mark L. Eberhard, of the CDC in Atlanta, and colleagues.

No environmental cause was found either, although neuropsychiatric problems, solvent exposure, and drug use were common among cases, the group reported in the January issue of PLoS One.

"In the absence of an established cause or treatment, patients with this unexplained dermopathy may benefit from receipt of standard therapies for coexisting medical conditions and/or those recommended for similar conditions, such [as] delusional infestation," they wrote.

Patients with this rare skin problem report fibers or solid materials emerging from poorly healing wounds that itch or have other disturbing sensations, like crawling insects, stinging and biting, or pins-and-needles.

But when the researchers biopsied lesions in patients reporting these symptoms, the materials they found -- mostly cotton fibers or skin fragments -- appeared to have been introduced into scabs created by chronic scratching or irritation, rather than erupting from the skin.

These findings suggested "the materials were from environmental sources (e.g., clothing) or possibly artifacts introduced at the time of specimen collection and processing," Eberhard's group wrote.

The group's Unexplained Dermopathy Study Team investigated a group of cases reported by public health officials in the San Francisco Bay Area, using the Kaiser Permanente of Northern California databases, which cover about 30% of the population in those counties.

Chart review turned up 115 patients at least 13 years old with Morgellons symptoms, for a prevalence of 3.65 cases per 100,000 enrollees in the managed care organization.

"Over 75% of our cases reported onset of their symptoms during or after 2002, but the epidemiologic importance of this is unclear as it also corresponds to the time when Internet postings related to this condition began to surface," the investigators noted in the paper.

The cases didn't meet criteria for clustering, but some similarities were seen in that 77% of the cases were Caucasian women.

Other common characteristics were multisystem complaints, with 70% reporting chronic fatigue and 54% reporting their overall health as poor or fair.

Neuropsychiatric problems also were common, with 59% having cognitive deficits that could not be explained by low IQ and 63% having clinically significant depression or other somatic complaints.

Testing turned up drugs in hair samples in 50%.

Most of the cases (78%) reported that they or someone in the household used solvents, such as paint thinner or charcoal lighter fluid, for hobbies or other activities.

The lesions themselves showed a wide variety of presentations, from papules and scars to plaques, patches, and even one cyst. Many were crusted; some were inflamed.

Forearms, back, chest, face, and lower legs were most commonly affected, with a median of 17 lesions per patient.

These lesions were "most consistent with arthropod bites or chronic excoriations," the researchers pointed out.

Some tested positive for bacteria, but no parasites or mycobacteria were detected.

"We were not able to conclude based on this study whether this unexplained dermopathy represents a new condition, as has been proposed by those who use the term Morgellons, or wider recognition of an existing condition such as delusional infestation, with which it shares a number of clinical and epidemiologic features," the group concluded.

Patients reported using many different over-the-counter, prescription, and alternative therapies in an attempt to alleviate symptoms, with nothing consistently reported effective.

Indeed, the biopsies turned up little that was treatable, the researchers noted.

Thus, skin biopsy may not be very useful without other supporting clinical evidence, although treating coexisting problems, like drug abuse and somatic symptoms, with currently available therapies might be one avenue to help these patients, they suggested.

The authors noted that the study was limited by the fact that case reports included only individuals with current or recent symptoms and used self-reported symptoms for definition, and by the fact that the investigators couldn't examine risk factors or temporal relationships with exposures, comorbidities, and symptoms.

The study was funded by the CDC.

Some of the researchers were employed by the CDC and some by Kaiser Permanente.

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